Eligibility
Model for End-Stage Liver Disease (MELD)
A new system, the Model for End-stage Liver Disease (MELD) has recently replaced the previous one. The MELD system is based on three simple to measure laboratory tests, and the MELD score is predictive of death within 3 months (the higher the score, the higher the risk of death). Candidates with sudden, acute liver failure are still allocated organs ahead of all other waiting patients.
While You Wait
While you’re on the wait list, you’ll have regular follow-up appointments with the transplant team and follow a set of important instructions. For example, you must tell us if:
- You’re hospitalized
- Your condition worsens
- Your address or telephone number changes
- You lose insurance coverage
- You travel out of town
- There are any other changes that may affect your medical care
- You need to have regular dental examinations and treat any tooth decay or other oral infections
You must be ready at all times to come to the hospital when called, and you can be called at any time for a transplant. Carry a pager or cell phone with you at all times. If you don’t have one, contact our office and we’ll assign you a pager. Also, you should continue to have regular appointments with your specialists and primary care physicians.
The first step in the transplant process is evaluation: the transplant team evaluates your condition and decides if you’re a good candidate for a transplant. Our team includes:
- Transplant surgeons
- An organ specialist
- A psychiatrist
- A social worker
- Nutritionists
- Nurses
- Transplant coordinators
- Other healthcare professionals
Usually within a week after you’re referred to us, a transplant coordinator will call you to discuss the evaluation process and set up your appointments. We’ll also do a preliminary financial and insurance coverage assessment.
Tests
For the evaluation, you’ll visit Strong Memorial Hospital twice, both times as an outpatient. During your first visit, you’ll have a number of diagnostic tests. You’ll have blood drawn and x-rays taken and you’ll be tested for blood type and other matching factors that determine whether your body will accept an available organ. During the second visit, you’ll talk to the transplant team about your test results. (The second visit is usually a week or two after the first, but the whole evaluation process can be completed within 12-48 hours for a critically ill person.) We strongly urge you to bring one or two other people, who will become your support system, to all meetings.
Among other things, the tests will show if you have complications or conditions that might adversely affect your surgery. Cancer, a serious infection, or significant cardiovascular disease would make transplantation unlikely to succeed. In addition, the team will want to make sure that you can understand and follow the schedule for taking medicines. If problems are found, you may be referred to the appropriate specialists at the University of Rochester Medical Center who can deal with them. You’ll also talk to a financial counselor about insurance and other ways covering the costs of the transplant and follow-up care.
Results
After the evaluation, the results are given to the Organ Transplant Patient Evaluation and Selection Committee, which uses the Patient Selection Criteria and Implementation Plan to decide if you’re a suitable candidate for an organ transplant.
If you don’t become a transplant candidate, the transplant team will support your primary care doctor, as appropriate, in managing your disease. If you do become a candidate, you’ll be put on the waiting list for a donated organ unless you have a living donor willing to donate an organ to you. If you have a living donor, the transplant surgery can be scheduled immediately.